Palliative care is a multidisciplinary approach to the holistic care and support for patients and families facing a life-threatening illness, improving quality of life while maintaining dignity from the time of diagnosis until death. For children, the spectrum of illness includes life limiting illnesses/conditions which may progress to death or may be severely disabling. Palliative care should be available to all patients as needed from birth until death and should be accessible at all levels of the health care service. Palliative care cuts across all health programs in the delivery of services. With the quadruple burden of disease in South Africa, an estimated 50% of all people who die in South Africa could benefit from palliative care services. While there are health system challenges to providing equitable access to quality palliative care services, there are available resources as well as existing legislation and policies which support the principles of palliative care and will enable the implementation of the palliative care policy and strategy using the existing service delivery platform. With guiding principles such as the right to health, patient centred and ethical care, equitable access, and quality evidence-based care, the vision of this policy is that all adults and children, including their families, facing the problems associated with life-threatening or life limiting illness will receive palliative care to maintain quality of life, dignity and comfort as well as manage pain throughout the course of the illness. The needs of palliative care patients at different stages of the illness trajectory are described. Referral pathways have been identified. The services available will range from a palliative care approach in the community and clinics to a generalist palliative care service at district hospitals to a specialist palliative care service at regional and tertiary hospitals. Centres of excellence will be established at academic hospitals to support education and research in palliative care. Access to hospices or sub-acute facilities will be availablefrom all levels of the health service. Packages of care for patients at different stages of the trajectory as well as at different levels of the service have been described. Training in palliative care is essential and includes in-service training of existing health care workers in the palliative approach, undergraduate training, postgraduate training and the development of a palliative care specialty to support the need for the different levels of services and to provide a career path for interested health professionals, ensuring sustainability of services. The goals and objectives have been developed based on the WHO health system building blocks for health services. The responsibilities of the National Department of Health are outlined with activities and targeted outcomes, which then guide the implementation plan for the provinces. The costs of setting up the service as well as of continued service delivery have been estimated, although ongoing mapping of services within provinces is required. The National Policy Framework and Strategy for Palliative Care is intended to assist policy makers, all relevant health programmes, professionals and workers in the health department as well as NGOs to understand the need for palliative care and to provide a guide to providing such care so that patients will experience a greater quality of life with less suffering while retaining their dignity when faced with a life-threatening illness.